Dynamic handgrip exercise for the evaluation of mitral valve regurgitation: an echocardiographic study to identify exert
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ORIGINAL PAPER
Dynamic handgrip exercise for the evaluation of mitral valve regurgitation: an echocardiographic study to identify exertion induced severe mitral regurgitation Mhd Nawar Alachkar1 · Annemarie Kirschfink1 · Julian Grebe1 · Mohammad Almalla1 · Michael Frick1 · Andrea Milzi1 · Wiebke Moersen2 · Michael Becker2 · Nikolaus Marx1 · Ertunc Altiok1 Received: 8 June 2020 / Accepted: 5 October 2020 © The Author(s) 2020
Abstract Handgrip exercise (HG) has been occasionally used as a stress test in echocardiography. The effect of HG on mitral regurgitation (MR) is not well known. This study aims to evaluate this effect and the possible role of HG in the echocardiographic evaluation of MR. 722 patients with MR were included (18% primary, 82% secondary disease). We calculated effective regurgitant orifice area (EROA) and regurgitant volume (RVOL) at rest and during dynamic HG. Increase in MR was defined as any increase in EROA or RVOL. We analyzed the data to identify possible associations between clinical or echocardiographic parameters and the effect of HG on MR. MR increased during dynamic HG in 390 of 722 patients (54%) (∆EROA = 25%, ∆RVOL = 27%). Increase of regurgitation occurred in 66 of 132 patients with primary MR (50%) and in 324 of 580 patients with secondary MR (55%). This increase was associated with larger baseline EROA and RVOL, but it was independent from other clinical or echocardiographic parameters. In secondary MR, dynamic HG led to a reclassification of regurgitation severity from non-severe at rest to severe MR during HG in 104 of 375 patients (28%). There was a significant association between this upgrade in MR classification and higher New York Heart Association (NYHA) class (OR 1.486, 95%-CI 1.138–1.940, p = 0.004). Dynamic HG exercise increases MR in about half of patients independent of the etiology. Dynamic HG may be used to identify symptomatic patients with non-severe secondary MR at rest but severe MR during exercise. Keywords Handgrip · Mitral valve regurgitation · Echocardiography Abbreviations EROA Effective regurgitant orifice area HG Handgrip HR Heart rate LA Left atrial LV-EF Left ventricular ejection fraction LVEDd Left ventricular end-diastolic diameter LVEDs Left ventricular end-systolic diameter MR Mitral regurgitation NT-proBNP NT-pro brain natriuretic peptide NYHA New York Heart Association PISA Proximal isovelocity surface area * Mhd Nawar Alachkar [email protected] 1
Department of Cardiology, Angiology and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
Department of Cardiology, Nephrology and Intensive Care, Rhein-Maas Hospital, Wuerselen, Aachen, Germany
2
RVOL Regurgitant volume sPAP Systolic pulmonary artery pressure TAPSE Tricuspid annular plane systolic excursion TTE Transthoracic echocardiograp
Background Handgrip exercise (HG) is a simple bedside maneuver to increase the intensity of murmur of mitral regurgitation (MR) during auscultation [1]. In addition, HG has been used in echocardiography as a means of stre
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